Capitol Hill Report: AAN Raises Medicaid Bump with White House Staff

APRIL 21, 2014

by Michael J. Amery, Esq., Legislative Counsel

AAN Pursues Medicaid Bump Inclusion at White House Meeting 
Last week, AAN Past President Dr. Bruce Sigsbee and I had an opportunity to meet with White House staff to press for the inclusion of a Medicaid bump extension in the President’s FY 2015 budget. 

It was a great way to start the day. With cherry blossoms in full bloom, we headed through significant security and entered the Eisenhower Executive Office Building that stands just west of the White House. We made our way up to the third floor and entered a conference room we were told had been William Howard Taft’s office when he served as Secretary of War in Theodore Roosevelt’s administration more than 100 years ago. 

Fortunately the issues didn’t reach the level of importance of those faced by Taft, but are nonetheless of great importance to neurologists and the patients they treat. White House staff made it clear that the administration understands the need to recognize cognitive providers in issues like the Medicaid bump and the primary care bonus. 

We left the meeting on the east side of the building which put us just a few yards from the Oval Office. I was hoping to get in a quick conversation with the president but unfortunately he wasn’t out walking his dog Bo. But we will follow up regularly to ensure that future efforts on this issue by the Obama administration include America’s neurologists.

NIH Porter Neuroscience Center Completed
From 2003 to 2010, one of the key messages of the Academy’s Neurology on the Hill events was a request for congressional funding to complete the John Edward Porter Neuroscience Research Center on the Bethesda campus of the National Institutes of Health (NIH). 

The completed center opened April 1. According to the NIH, “this state of the art facility brings together neuroscientists from 10 institutes and centers across the NIH in an effort to spur new advances in our understanding of the nervous system in health and disease.”

Anyone who was part of those Neurology on the Hill efforts should be proud of the accomplishment and those lobbying on the Hill today should take solace in the fact that no matter how slow the process, the work you do today can have a profound impact on the future.

Join Us at These Annual Meeting Events
Are you coming to the AAN Annual Meeting in Philadelphia next week? If so, there are many opportunities to discuss advocacy issues, including a couple with members of Congress. We want to hear from you so come to any or all of the following:

  • The Brain Health Fair kicks off the meeting on Saturday, April 26, with special guest US Rep. Chaka Fattah (D-PA), who is a leader in the effort to improve neuroscience research.
  • Members of the AAN Government Relations Committee will host a Meet & Greet to discuss the AAN's legislative priorities on Monday, April 28, from 12:00 p.m. to 1:30 p.m. in Room 304 of the Convention Center. US Sen. Bob Casey (D-PA), a member of both the Senate Finance Committee and Health Committee, will be a special guest.
  • AAN coding experts will be on hand in Academy Central throughout the week to answer your coding questions.
  • The Health Policy booth in Academy Central will feature members and staff available to discuss advocacy, payment and practice issues, guidelines, and quality reporting.
  • If you want to talk politics with me, Derek Brandt, or any number of AAN leaders, come to the BrainPAC booth anytime between 8:00 a.m. to 6:00 p.m. You can also follow me and events at the meeting using @MikeAmeryDC and #AANAM.

Advocating for Proper, Flexible Quality Outcome Measures
By Bruce Sigsbee, MD, FAAN, AAN Past President

In an effort to develop meaningful quality measures, a great deal of importance is being placed on outcome measures, interventions that accelerate or improve the outcome. Given the Centers for Medicare & Medicaid Services’ (CMS) increased focus on quality measures and value-based payment with respect to physician reimbursement, I spoke with CMS quality staff last week to ensure that the value of neurologic care continues to be recognized. Now more than ever it is important that the voice of neurologists and our patients are represented in value-based payment programs. I was pleased to hear that the AAN and CMS agree that for neurology-specific quality measures there needs to be flexibility because there are many neurologic disorders where there is no meaningful treatment or improvement to clinical outcomes, such as Parkinson’s disease or ALS. However, neurologic care can certainly improve the quality of life of these individuals. 

On the call, Kate Goodrich, MD, director of Quality Measurement and Health Assessment, stated she understands that for patients with degenerative neurologic conditions, patient outcome measures might not always be appropriate. However, she believes that there are patient outcome measures that would help neurologists demonstrate their quality to payers, patients, and caregivers. Dr. Goodrich also stated those outcomes might include patient-reported quality of life and function, symptom management, patient safety, and caregiver experience. She recommended that the AAN work with researchers to identify valid and reliable patient-reported outcome measures for quality of life or symptom management. Dr. Goodrich also suggested the AAN explore economic outcome measures, such as alignment with the AAN’s Choosing Wisely® recommendations for appropriate use.

Because of the looming increase in dementia patients due to an aging population, Dr. Goodrich highlighted the importance of improving dementia care for patients and assessing the caregiver experience. She emphasized the need for a suite of dementia measures that includes measures of safety, cognitive decline, and caregiver experience.

The National Quality Forum, which vets and endorses measures for CMS, appears to have a single-minded focus on clinical outcome measures, which is why it was necessary for the AAN to have a conversation with CMS and explain the need for flexibility and recognition of other measures, like quality of life, in quality reporting programs. 

For more information about AAN’s quality measure efforts, please

Odds and Ends
By Tim Miller, Senior Program Manager, Communications and State Advocacy

In-office Exception Under Attack in California: Last week, the AAN co-signed a letter with several other physician organizations opposing legislation (SB 1215) that would eliminate the in-office exception to the self-referral prohibition. AAN staff also sent an action alert to all members in California asking them to contact their members of the California Assembly prior to an April 28 committee hearing. If AAN members in other states learn of any movement toward elimination of the in-office exception at the state or payer level, please contact Tim Miller.

Letter to MedPAC Expresses Concerns over Continued Lack of Inclusion:
The Cognitive Specialty Coalition (CSC) and the American Psychiatric Association have sent a letter of concern to the Medicare Payment Advisory Commission (MedPAC) regarding the lack of recognition for cognitive care specialists in discussions about improving the practice climate. 

The most recent MedPAC commission stated the “physician fee schedule must be rebalanced to achieve greater equity of payments between primary care and other specialties.” The commission also recommended the primary care bonus be continued. 

The AAN and the rest of the CSC agree that measures must be taken to improve access to primary care, but also believe the more appropriate distinction in accomplishing this is between physicians who primarily provide evaluation and management and those who provide procedural care.

MedPAC is required by law to review Medicare payment policies and to make recommendations to Congress. However, Congress does not always act on these recommendations.


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